Doctors at Mumbai’s Saifee Hospital celebrated on Thursday when Eman Ahmed Abd El Aty, 36, lifted her right hand to her forehead for the first time in three years. In Mumbai since February 11 for weight-loss surgery, the world’s heaviest woman weighed 498 kg in Alexandria two months ago. The plan is to make her lose 200 kg in six months.“We’ve charted her treatment for six months, I’ve drawn and scripted the whole procedure like a film script,” says Dr Muffazal Lakdawala, chairperson of Institute of minimal access surgical sciences and research centre, Saifee Hospital, who is doing the surgery. “Since diagnostic tools like MRI cannot be used, we are relying on clinical tools to plan outcomes. We have no references, so we have a plan B for everything,” says Dr Lakdawala.February 11, 2017:
Eman arrives At Saifee Hospital in Mumbai for weight-loss surgery in March. She is medically fragile and unfit for surgery, so a team of doctors across seven specialties – surgery, nutrition, physiotherapy, endocrinology, nephrology, neurology and genetics -- are working in tandem at Mumbai’s Saifee Hospital to optimize her health.Here’s how doctors plan to being her weight to 300 kg in six months.1. Diet
A month ago, Eman weighed 498 kg. She now weighs 460 kg, having lost close to 40 kg after the Saifee team stepped in a month ago to supervise her diet and change her prescription to better control her hypothyroidism and other clinical abnormalities.January 20, 2017:
Eman put on 1,200 calories high protein-low card diet of chicken, fish and dairy in Egypt to bring her weight down for travel to India. Her weight comes down from 498 kg to 475 in two weeks.
February 13, 2017:
Police cars, ambulance and the Consul General of Egypt with Eman Ahmed on the way to Saifee Hospital, ahead of her bariatric surgery in Mumbai on Saturday morning. (Prashant Waydande/HT Photo)
Eman given a 1,100-1,200 calories liquid diet that has brought her weight down to around 460 kg in six days.Diet: Liquid diet of 1,100-1,200 calories that includes 70 gm protein supplement (about 300 gm of chicken) low in phosphorus and potassium; three servings (600 ml) of skimmed milk; and fibre supplements to make her feel full.“Eman had significant protein loss because of obesity and the challenge is giving her protein while maintaining a healthy creatinine, phosphorus and potassium balance,” says Dr Carlyne Remedios, senior nutritionist, Saifee Hospital. “The diet will continue till two weeks after surgery, and then she will be able to have semi-solid mashed) foods like soup, daal and kitchdi. Four weeks after surgery, she can have regular solid food in small amounts,” says Dr Remedios. “She can gradually increase the amount over time but will be able to eat less than half she normally did.”2. Physiotherapy
Her size is a challenge. Eman is wider than she is high and her muscles can’t support her weight. She’s is almost 5 feet wide, measuring 151 cm wide (59.5 in, 4.95 ft) and 141 cm tall (55.5 in; 4.6 ft) and hasn’t walked in more than two decades.A stoke three years ago impaired her speech, her ability to swallow (she coughs when she drinks water) and made the right side of her body weak.February 13, 2017: Eman begins passive physiotherapy for speech, muscular deglutition to enable her to swallow and improvement in the right side of her body. She moved her right hand up to her forehead for the first time in three years late on Thursday evening.3. Kidneys
Her kidneys are compromised, she had creatinine levels 3.6 (normal range 0.5 to 1.1 mg for men) and uric acid of 15 (normal range 2.4-6.0 mg/dL in women) and potassium 6.7 mg.January 29, 2017: Three nephrologists from Saifee Hospital flew to Alexandria to make her fit to fly, and put her on medication to bring her creatinine levels to 2.5 February 12, 2017: “Her creatinine has been 1.9 since she came to Mumbai, we will bring it down to healthy range before surgery,” says Dr Hemal Shah, head of nephrology, Saifee Hospital. “She’s lost some weight and as her obesity goes down, her kidney function will improve further and help flush out excess fluid from her body and subcutaneous tissue, which adds to weight and raises infection risk when it oozes from pressure sores she has from lying in bed.”
Eman Ahmed Abd El Aty (left) has not stepped out of her house in Cairo for the past 25 years. (HT Photo)
February 13, 2017: The dose of the drug Eltroxin has been raised from 300 mcg to 450 mcg to control her hyperthyroidism. “Eman also has hypogonadism (the ovaries are producing little or no sex hormones), but I want her to stabilise further before treating her for it,” says Dr Shehla Sheikh, endocrinologist at Saifee Hospital. “The target is to bring her TSH to within the normal range (0.5 to 5 uU/ml from 15 uU/ml) before surgery. Her prescription ws revised on Feb 13 and her levels will be reassed bagaiin next week,” said Dr Sheikh.5.Genetic tests
February 13, 2017: Samples from Eman were collected and sent to the US to be tested using ObèCORE, a 36-genes panel for monogenic obesity, to determine whether her weight gain is caused by genetic diseases such as Bardet-Biedl syndrome, Cohen syndrome, Alstrom syndrome, and Prader-Willi.“Obesity is caused by a complex interplay between multiple genes and environmental factors, and rarely does a specific variant of a single gene causes inherited obesity in families (monogenic obesity).” says Zoya Brar, managing director, Core Dagnostics, from where samples have been sent to its Silicon Valley office to get tested. “Among the significant genes she is being screened for anomalies in the LEP gene for Leptin deficiency, Leptin Receptor Deficiency, POMC and MC4R that increase hunger and food intake.“The results are expected around March 7, after which the surgeons will personalixe treatment further by determining how she will respond to surgery or if her obesity can be controlled with medication.” says Brar.
An image of Egyptian national Eman Ahmed Abd El Aty, who weighs around 500 kilograms (1,100 pounds), displayed at a press conference in Mumbai on February 13, 2017. (AFP)
The bariatric surgery will undergo sleeve gastrectomy, a laparoscopic surgery that reduces the size of the stomach to 10-15% of its original size by surgically removing a large portion of the stomach along the greater curvature. It’s an irreversible procedure.“I chose sleeve gastrectomy because it is technically easier. Our aim is to get her fit enough to fight another day by bringing her weight down to 300 kg in six months,” says Dr Lakdawala. “We’ve planned for surgery around four weeks for now because the results of her genetic tests will be in and help us optimize treatment and recover. In some cases of monogenic obesity, surgery it not needed and drugs are enough to being down weight.”“Our aim is to make her sit up and move in six months and over the next two tyears, get her back on her feet,” says Dr Lakdawala.Follow @htlifeandstyle for more